Keywords
Colorectal Surgery
Surgical Staplers
Suture Techniques
Quality Improvement
Abstract
BACKGROUND: Anastomotic leakage remains a major determinant of
morbidity, mortality and resource use after colorectal resection. Although several
technical variables are under direct surgical control, evidence on their individual
contribution to leakage risk remains inconsistent, and local audit data linking
technique to outcome are scarce.
METHODS: This retrospective observational study included 315 consecutive
adult patients undergoing colorectal resection with primary anastomosis at a single
centre between January 2018 and December 2024. Anastomoses were categorised as
hand-sewn (by configuration, suture calibre and pattern) or mechanically stapled
(by circular stapler diameter). Anastomotic leakage was defined according to the
International Study Group of Rectal Cancer criteria. Categorical comparisons used
Fisher's exact and Fisher–Freeman–Halton exact tests, with odds ratios and 95%
confidence intervals calculated for selected comparisons.
RESULTS: Overall leakage occurred in 25 of 315 anastomoses (7.9%).
Leakage rates did not differ significantly between hand-sewn (6.5%) and stapled
(9.7%) techniques (odds ratio 0.65, 95% CI 0.28–1.47; p=0.306). Within hand-sewn
anastomoses, neither configuration, suture calibre nor suturing pattern was
significantly associated with leakage. Among stapled anastomoses, leakage rates
ranged from 0% to 22.2% across diameters, with no significant global association
(p=0.240); a post hoc comparison showed higher odds of leakage with 33-mm than
32-mm staplers (odds ratio 4.79, 95% CI 1.07–21.47; p=0.050), based on only 18
patients.
CONCLUSION: In this single-centre cohort, no technical variable showed a
statistically robust association with anastomotic leakage, although the signal
observed with larger circular staplers warrants further investigation. These findings
support systematic documentation of anastomotic technique and continuous
outcome audit as tools for local quality management, pending prospective
multicentre validation.